We will develop a University of Alabama at Birmingham-Aga Khan University multidisciplinary research team with its major goal the reduction of infection-related perinatal mortality in Pakistan. To accomplish this goal, we will continue to build the UAB-AKU research relationship around a series of studies on perinatal infection and pregnancy outcome. The first study will characterize two populations of Pakistani pregnant women. A cohort study consisting of 1500 urban and later 1500 rural women will be performed in which data will be collected near mid-pregnancy on infections such as bacterial vaginosis, gonorrhea and chlamydia, and on various pregnancy-associated cervicovaginal and serum markers of infections. These data will be correlated with pregnancy outcome. We will also collect psychosocial, nutritional, medical and dental data and correlate these results with bacterial infection of the vagina, the infection markers and with pregnancy outcome. The goal of this study is 1) to determine the current pregnancy outcomes in two Pakistani populations, 2) to determine the prevalence of vaginal infections and markers of infection in these two populations, and 3) to determine the prevalence of various psychosocial, nutritional, medical and dental factors associated with vaginal infection, markers of infection and adverse pregnancy outcomes. Upon completion of the urban cohort study, women identified as high risk for perinatal death because of a previous perinatal death will be invited to participate in a randomized trial of prenatal and perinatal antibiotics to reduce infection-related perinatal mortality. In this study, women who have had a previous stillbirth or a neonatal death will be randomized to one week of treatment with metronidazole and erythromycin or placebos in the late second trimester, with a repeat course of antibiotics or placebo in labor. The primary endpoint will be perinatal mortality. Our second attempt to decrease infection-related mortality will be in a randomized trial of an intrapartum and infant chlorhexidine wash versus placebo washes with saline. With the completion of these projects, not only will we have answered some very important questions related to infections and pregnancy outcome, but AKU, in partnership with UAB, will have developed superb rural and urban pregnancy-related research infrastructures tightly linked to their developing maternity health care systems.